Health providers may experience information and financial loss during transition to ICD-10

Health providers may experience information and financial loss during the mandated conversion from the current International Classification of Diseases to its new and improved version, report researchers at the University of Illinois at Chicago.

The study, appearing in the March issue of the Journal of Oncology Practice, looked at coding ambiguity for hematology-oncology diagnoses to anticipate challenges all providers may face during the transition from ICD-9-CM to ICD-10-CM.

The researchers chose to look at hematology-oncology because prior research suggested that, compared to other sub-specialties, it would have a simpler transition, due to fewer ICD-10 codes and less convoluted mappings.

The nation's health care system is scheduled to fully implement ICD-10 on Oct. 1, and many doctors and hospitals are still preparing for the transition. The system is used to classify and code all diagnoses, symptoms and procedures for reference in managing all aspects of health care - from insurance reimbursement to staffing decisions to supply procurement.

The ICD-10-CM includes more than 68,000 diagnostic codes, compared to 14,000 in ICD-9-CM. The Centers for Medicare and Medicaid Services provides a general equivalent mapping (GEM) code translation system, but it's complex and often difficult even for billers and coders to interpret, according to the researchers.

Codes often do not map one-to-one or one-to-many, says Andrew Boyd, UIC assistant professor in biomedical and health information sciences and one of the study's co-authors. A cluster of codes might map to several ICD-10 codes, which might then map back to different ICD-9 codes, he said.

In the study, the researchers used 2010 Illinois Medicaid data to identify ICD-9-CM outpatient codes and the associated reimbursements used by hematology-oncology physicians. The researchers identified 120 codes with the highest reimbursement for analysis.

They also looked at ICD-9-CM outpatient diagnosis codes and associated billing charges used by University of Illinois Cancer Center physicians from 2010 to 2012 and selected the 100 most-used codes.

Using a web-based tool developed at UIC, the researchers input the ICD-9 codes and translated them into ICD-10 codes. They looked at whether the translation made sense; whether a loss of clinical information occurred; and whether a loss of information had financial implications.

"What we found was the transition from ICD-9 to ICD-10 led to significant information loss, affecting about 8 percent of the Medicaid codes and 1 percent of the codes in our cancer clinic," said Dr. Neeta Venepalli, UIC assistant professor of hematology/oncology and first author of the study.

In looking at the financial implications, the researchers found that 39 ICD-9-CM codes with information loss accounted for 2.9 percent of total Medicaid reimbursements and 5.3 percent of UI Cancer Center billing charges.

The report highlights the 39 codes "to help identify that there might be trouble with reimbursement for these codes," said Boyd.

http://www.medicalnewstoday.com/releases/273992.php

Doctors Lag Far Behind On ICD-10 Readiness

6/15/2013 @ 12:30PM |8,513 views

Less than 5 percent of physician practice have made “significant progress” when rating their overall readiness for tens of thousands of new government-mandated “ICD-10” codes used to describe diseases and hospital procedures in the insurance billing process, a new study shows.

Though the conversion to 140,000 new codes that medical-care providers will use in order to bill government and private insurers doesn’t occur until Oct. 1, 2014, it doesn’t look like doctor practices will be ready.

“It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades,” said Dr. Susan Turney, president and chief executive officer of the Medical Group Management Association.New research out this week by the Medical GroupManagement Association shows “only 4.8 percent of practices reported that they have made significant progress when rating their overall readiness for ICD-10 implementation.” More than 1,200 medical groups representing more than 55,000 doctors were part of the research.

The conversion is being required by the Centers for Medicare & Medicaid Services to provide more specificity to the existing coding system. The current ICD-9 codes have limited information about medical conditions and hospital procedures while the new ICD-10 code “sets provide flexibility to accommodate future health care needs, facilitating timely electronic processing of claims by reducing requests for additional information to providers,” Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services wrote earlier this year to the American Medical Association, which has urged a delay in implementing the new codes.

At the American Medical Association House of Delegates meeting in Chicago, which runs through Wednesday of next week in Chicago, doctors are endorsing legislation in Congress to try to prevent the Obama administration from implementing ICD-10. The AMA is also calling for alternatives.

MGMA’s Turney said the transition will impact documentation of clinical care, physician productivity in how they care for patients and reimbursement to doctors from insurance companies and government payers at a time doctors are also trying to get their practices ready for electronic health records, or EHR.

“Adding to the implementation challenge and clearly taxing all stakeholders, ICD-10 will arrive at the same time that a number of other transformative federal policies go into effect, such as health insurance exchanges and Stage 2 of the (Centers for Medicare & Medicaid Services) Meaningful Use EHR Incentive Program,” Turney said.

The ICD-10 conversion is also adding costs to health insurance companies and will impact the likes ofAetna AET -1.72% (AET), Cigna CI -1.83% (CI), Humana HUM -0.65% (HUM), Wellpoint (WLP) andUnitedHealth Group UNH -0.55% (UNH)as they use the codes in their claims processing and paying of physicians and other providers.

“A successful transition to ICD-10 requires coordination between providers and their vendor, clearinghouse and health plan trading partners,” Turney said. “Our data suggest that many practices are in the dark in terms of moving forward with ICD-10 as this coordination has not yet occurred.”

MGMA, the American Medical Association and various other medical-care provider groups worry the health care industry will not be ready, saying they still have to train their office staffs, buy the right computer systems and grapple with the mountain of administrative and related changes necessary that increases the number of diagnostic codes to about 69,000 from nearly 14,000 while the number of inpatient procedure codes rises to about 87,000 from about 3,000.

“Without the necessary software changes and testing, practices will have no confidence that they will be paid for the care they deliver to their patients after Oct. 1, 2014,” Turney said.

Medicare administrator Tavenner has said there are no plans to delay or cease implementation, saying the conversion to ICD-10 was already delayed a full year from October of this year when it was originally scheduled to be implemented.

http://www.forbes.com/sites/brucejapsen/2013/06/15/doctors-lag-far-behind-on-new-medicare-diagnosis-codes/